The opinion of the court was delivered by: James Knoll Gardner, United States District Judge
RICHARD R. GALLI, ESQUIRE On behalf of Plaintiff RICHARD P. ABRAHAM, ESQUIRE GREGORY B. HELLER, ESQUIRE On behalf of Defendant
This matter is before the court on the Motion for Summary Judgment of Plaintiff Liberty Life Insurance Company filed July 30, 2010, Defendant's Motion for Summary Judgment filed July 30, 2010, and Defendant's Amended Motion for Summary Judgment filed August 24, 2010 with leave of court. For the following reasons, I grant plaintiff's motion for summary judgment, and I deny defendant's motion for summary judgment and amended motion for summary judgment. Specifically, I rule that plaintiff Liberty Life Insurance Company is not obligated to pay benefits under an accidental death policy it issued to defendant's decedent.
Jurisdiction in this case is based on diversity of citizenship pursuant to 28 U.S.C. § 1332. Specifically, plaintiff Liberty Life Insurance Company is a South Carolina corporation with its principal place of business in South Carolina. Defendant Veronica N. Figueroa, as Administratrix of the estate of decedent Ernesto Figueroa, is a citizen of Pennsylvania. The amount in controversy exceeds $75,000.
Venue is proper because the events giving rise to this action occurred in Lehigh County, Pennsylvania, which is in this judicial district. 28 U.S.C. § 1391.
Plaintiff initiated this action on July 9, 2009 by filing a civil Complaint for Declaratory Judgment in this court. The Complaint seeks a declaration that plaintiff Liberty Life Insurance Company is not obligated to pay benefits under an accidental death policy it issued to defendant's decedent Ernesto Figueroa, also known as Ernesto F. Carrion. On September 4, 2009, defendant Veronica N. Figueroa, as Administratrix of decedent's estate, filed an Answer to the Complaint.
On July 30, 2010, the parties filed cross-motions for summary judgment. Defendant filed a response to plaintiff's motion on August 23, 2010. By Order dated August 24, 2010, I granted defendant's unopposed request to file an amended motion for summary judgment for the limited purpose of listing, in numbered paragraphs, the material facts about which defendant contends there is no genuine issue, and I directed the Clerk of Court to file defendant's proposed amended motion. That amended motion now appears on the docket as Defendant's Amended Motion for Summary Judgment, at Docket Entry 27.
On August 25, 2010, I heard oral argument on the cross-motions for summary judgment, and took the matter under advisement. Hence this Opinion.
In considering a motion for summary judgment, the court must determine whether "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue of material fact and that the moving party is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(c). See also Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247, 106 S.Ct. 2505, 2509-2510, 91 L.Ed.2d 202, 211 (1986); Federal Home Loan Mortgage Corporation v. Scottsdale Insurance Company, 316 F.3d 431, 443 (3d Cir. 2003). Only facts that may affect the outcome of a case are "material". In making this determination, the "evidence of the non-movant is to be believed" and all reasonable inferences from the record are drawn in favor of the non-movant. Anderson, 477 U.S. at 255, 106 S.Ct. at 2513, 91 L.Ed.2d at 216.
Although the movant has the initial burden of demonstrating the absence of genuine issues of material fact, the non-movant must then establish the existence of each element on which it bears the burden of proof. See Watson v. Eastman Kodak Company, 235 F.3d 851, 857-858 (3d Cir. 2000). The non-moving party cannot avert summary judgment with speculation or by resting on the allegations in its pleadings, but rather it must present competent evidence from which a jury could reasonably find in their favor. Ridgewood Board of Education v. N.E. for M.E., 172 F.3d 238, 252 (3d Cir. 1999); Woods v. Bentsen, 889 F.Supp. 179, 184 (E.D.Pa. 1995).
Based upon the pleadings, record papers, exhibits, and each party's statement of undisputed facts, the pertinent undisputed facts for purposes of the cross-motions for summary judgment are as follows.
Defendant Veronica N. Figueroa is the Administratrix of the estate of Ernesto Figueroa, also known as Ernesto F. Carrion.
She is the daughter of Ernesto Figueroa. Mr. Figueroa and Margarita Carrion were joint insureds under a group decreasing term accidental death insurance policy issued by Liberty Life Insurance Company of Greenville, South Carolina. The coverage became effective on December 1, 1998 and covered the amount of the balance of the insured's mortgage loan as of the time of death in the event of a covered accidental death.
Mr. Figueroa and Margarita Carrion were the borrower and co-borrower, respectively. On the date of the application, November 1, 1998, the mortgage loan balance and the initial amount of insurance were $107,068.45.
On January 30, 2008, Mr. Figueroa died at Lehigh Valley Hospital. He had been a patient at the hospital from his arrival at the Emergency Department at 8:32 p.m. on January 29, 2008 until his death on January 30, 2008 at 7:37 a.m.
The medical records of Lehigh Valley Hospital provide a record of Mr. Figueroa's complaints, his medical care and the chronology of events from his arrival at the hospital until his death. The intake form signed by Mr. Figueroa described the reason for his presence as "stabbing pain in the stomach, severe stomach problems, vomiting consisting [sic] for the past two days."*fn1 The hospital records state that Mr. Figueroa's chief complaint was abdominal pain.
The physician who examined Mr. Figueroa's abdomen, Dr. Conroy, noted "Mild tenderness diffusely. No guarding, rebound tenderness or Murphy's sign present. Abdomen soft."*fn2 A second doctor, Dr. Frei,*fn3 agreed with Dr. Conroy's assessment and noted that he intended to do a CT scan.*fn4
Dr. Conroy was present at 6:20 a.m. for the administration of an IV injection of contrast dye. About 70 seconds into the injection, Mr. Figueroa started to get very nauseous and began vomiting, developed erythema, and stated he was itchy. He then began to seize. Dr. Frei was called, and found Mr. Figueroa vomiting, awakened slightly; and he appeared red, and his tongue appeared swollen. Mr. Figueroa was ...